HELPING STUDENTS SAVE LIVES
NEWS P3
SUPPORTING VICTIMS OF ABUSE
FEATURES P8
LIVING WELL WITH DEMENTIA
FEATURES P10
ISSUE NO. 341 JULY 2016
GLORIOUS
GLASGOW
ALL THE ACTION FROM RCN CONGRESS P2,3,8,14,15
WWW.RCN.ORG.UK/BULLETIN
2 NEWS
Unit faces axe
The RCN represents nurses
and nursing, promotes
excellence in practice and
shapes health policies.
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Congress images by Steve Baker
Ballooning in Barbados?
‘Fight for nursing’
In a rousing speech to members
at the RCN Congress opening
ceremony, President Cecilia Anim
urged nursing staff to find their
voices and fight for the profession.
Reflecting on key successes and
challenges over the past year, she
accepted that nurses are working in
tough times, but encouraged them
to gain strength from patients “who
need us like never before”.
“Getting involved makes real
change happen,” she stressed,
as she spoke of the power of
collective campaigning in getting
nursing added to the list of
shortage occupations. “Remember,
the things that matter most are the
things worth fighting for.”
Nominations are now open
in the elections for the next RCN
president and deputy president.
Visit www.rcn.org.uk/elections
Department of Health plans to cut
costs by axing its nursing policy
unit put patient care at risk, the
RCN has said. Director of Nursing,
Policy and Practice Dame Donna
Kinnair said without senior
nurse leadership at the heart
of government, the profession
would always be in the position of
trying to influence policy from the
outside, “which is not only bad for
nursing, but also bad for patients”.
The RCN will
campaign for a
permanent expert
voice to be at
the heart of the
department following
an impassioned
debate at Congress.
See page 7 for more.
Members blast
loan plans
Government proposals to scrap
the bursary and make nursing
students in England pay tuition
fees have been condemned
by a majority of the 17,000
respondents to an RCN survey.
Almost 90 per cent rejected the
plans, which would see bursaries
replaced with loans and could
mean nurses starting their careers
with debts of up to £60,000.
These proposals
represent a
huge gamble
with the future
of the nursing
workforce
RCN Chief Executive
Janet Davies
Results from the survey helped
shape the RCN’s response to the
Government’s consultation on its
funding plans. See page 9 for more.
Funds for training?
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A debate on whether employers
should provide individual training
budgets for registered nurses in
the light of revalidation proved
controversial at the RCN’s annual
Congress. There was little consensus
among members, who ultimately
decided to vote against instructing
the College to lobby employers on
the issue. Employers don’t currently
fund continuing professional
development, so it is unlikely they
would fund this, argued Jane
McCready. “Let’s pick the battles
we really need to win,” she said.
Invest to save public health
The RCN will insist the Government reinstates adequate
funding for public health following a clear instruction from
members at Congress. Budgets in England have been slashed
by £200 million in the past year. “To cut the public health
budget is short-sighted, illogical and a false economy,” said
Gwen Vardigans.
RCN BULLETIN JULY 2016
3
Safe staffing, free tuition
and protected pay
Scotland’s First Minister Nicola Sturgeon made three key
nursing pledges at RCN Congress in Glasgow
Helping students
save lives
The RCN will now campaign for
compulsory cardiopulmonary
resuscitation (CPR) training in
schools following a lively debate at
Congress. Valerie Douglas urged
members to support the motion
by insisting “the cost will be low
but the impact will be enormous”.
There are approximately 60,000
cardiac arrests in the UK every
year. Four out of five that happen
outside of hospital occur in the
home, but the chance of survival
is often lost in the time it takes for
emergency services to arrive.
Angela Lee, who backed the
proposal, said the biggest barrier
to more bystanders helping is
fear. But children, she said, are a
“blank page, waiting for life skills
to be written on”.
Focus on safety,
not targets
The RCN has said patient safety
must take precedence over
financial targets. The College
was responding to reports that
NHS Improvement is to publish
guidelines emphasising “safe and
sustainable” rather than purely
“safe” staffing. Sources say the
work could undermine guidance
produced by the National Institute
for Health and Care Excellence.
Janet Davies, RCN Chief Executive,
said: “There is a danger some key
issues from the Francis report may
be forgotten, and financial targets
will again take priority”.
RCN BULLETIN JULY 2016
Safe nurse staffing levels will become
enshrined in Scottish law First Minister
Nicola Sturgeon told a packed
Congress audience.
Innovative workforce planning tools
created with the RCN’s help have made
sure health boards can plan for the
number of staff needed to provide the best
possible care for patients. “To build on our
record, we will enshrine these planning
tools in law,” said Ms Sturgeon.
A further pledge to retain free tuition
and bursaries for nursing and midwifery
students in Scotland was greeted with
a standing ovation. “The guarantee I’ve
given today is 100 per cent,” said the
First Minister.
Calling the Westminster Government’s
proposals to cut bursaries “shamefully
short-sighted” and “wrong-headed”,
she said: “Unlike the UK Government,
we recognise the role and contribution
of student nurses and the demands
they face. That is why I’m confirming
our commitment.
“The UK Government’s actions are the
wrong choice for nursing and the wrong
choice for the NHS. Reducing support for
nursing students today might mean that
there’s simply not enough highly qualified
support to care for patients tomorrow.”
Reducing support for nursing
students today might mean
there’s simply not enough
support to care for
patients tomorrow.
On pay and conditions, Ms Sturgeon
made a further guarantee that the Scottish
Government would continue to respect
the recommendations of the independent
NHS Pay Review Body, saying there was
no point in having such a body if what they
said was then ignored.
Prior to her arrival, Congress delegates
voted overwhelmingly in favour of
lobbying governments in England,
Scotland and Northern Ireland to follow
Wales in introducing safe nurse staffing
levels legislation.
WWW.RCN.ORG.UK/BULLETIN
4 NEWS
A&E pressures ‘the new normal’
said more and more staff were
leaving their roles in A&E, often
after a matter of months. “The
attrition rate of nurses is at a
level it has never been before,”
she said.
The A&E crisis is not confined
to England. Roisin Devlin, an
emergency nurse practitioner
from Northern Ireland, said:
“We’ve now got to the point where
we normalise the abnormal –
nurses are leaving shifts in tears,
for example.”
Despite the
best efforts
and dedication
of staff, these
pressures
are affecting
patients at every
stage in their
treatment
RCN Chief Executive Janet Davies
added: “Having once been the
preserve of the worst weeks of
winter, overwhelming pressure
and major incidents have sadly
become the new normal.
The RCN has issued a stark
warning about pressures on A&E
services, saying high demand
and major incidents have become
commonplace throughout the year.
country there are examples of
beds being placed in corridors
and patients being treated in
ambulances while they queue up
to enter hospitals.
Across England, the hospital
sector is feeling the strain of
financial pressures and increased
demand, with the effects most
visible in A&E units. Around the
These conditions have a negative
effect on staff as well as patients.
Nursing journal
gets new look
RCN centenary
poem launched
Nursing Standard, the flagship
journal of RCNi, the RCN’s
publishing company, has a
new look. The weekly title has
chronicled nursing’s evolution
to an all-graduate profession for
the last three decades and, along
with RCNi’s 10 specialist journals,
was relaunched at Congress after
extensive research among nursing
staff. The revamped specialist
journals and their websites will be
unveiled over the coming months.
Visit www.rcni.com
A poem to celebrate the RCN’s
centenary has been revealed. 100
years, written and performed by
RCN member Molly Case (pictured),
explores the history of the world’s
largest professional nursing union
and the journey of the nursing
profession over the past century.
WWW.RCN.ORG.UK/BULLETIN
Janet Youd, Chair of the RCN
Emergency Care Association,
“Despite the best efforts and
dedication of staff, these
pressures are affecting patients at
every stage in their treatment.
“It is time we had a serious look at
how long hospitals can continue
to function when they are
consistently under-funded and
under-staffed.”
Visit http://
tinyurl.com/zqu9hgf
to find out more
about and join the
RCN Emergency Care
Association
For there, below
the drape, a
landscape, not a
patient, begins to
take shape.
“I hope everybody finds
something for them within the
poem,” said Molly. View a film
of 100 years at http://tinyurl.com/
rcn100years
RCN BULLETIN JULY 2016
5
From the heart
Inspirational nurses honoured
The RCN has congratulated the “remarkable
nurses” recognised in the Queen’s 90th
birthday honours list. Those awarded
honours include Professor Ruth Northway,
RCN Fellow and Chair of the RCN Research
Society, who received an OBE for services to
learning disability nursing.
RCN Nurse of the Year 2011 Fiona Murphy
was awarded an MBE for a career dedicated
to improving support for dying patients and
their families.
Rose Gallagher, RCN Professional Lead for
Infection Prevention and Control, was also
awarded an MBE for services to nursing,
infection prevention and control.
Got a nursing secret
to share?
The RCN, in collaboration with the RCN
Foundation, is launching a new project
to gather examples of best practice and
support members to showcase innovations
in their workplace.
The iniative, celebrating the nursing
contribution to high quality care, is part of
the RCN’s centenary celebrations and will
target members who want to publish their
ideas but feel they lack the time, confidence
or experience to do so alone. A small team
of experts will be on hand to support those
members in disseminating their innovation.
Visit www.rcn.org.uk/innovation100 to find
out more and get involved.
VIEW
The THE
view from
here
FROM HERE
Feedback
Call to action
What I’m thinking
Browes
OnSimon
the web
Clinical director
Images celebrate
contemporary nursing
I work as an advanced practitioner and
Thesenior
month
ahead
manager
in a provider organisation,
delivering NHS care 24/7. We are
redesigning our local health and social
care services to become an “integrated
urgent
care system”. A lot of work has
In the
media
been done trying to understand our
communities and how and why they use
services. The conversation has moved
from what is needed 24/7 to what people
In my day job
want. There is no clear consensus on this.
The fact is we’re all trying to do more
with fewer resources. We’re stretching
Theourselves
way things
furtherwere
and doing a remarkable
job. But this is not sustainable. Nurses are
getting tired, burnt-out, disillusioned and
fed-up.
Political action
Winners announced in RCN
centenary photography
competition
Anthony Baines is the gold award winner
in the RCN’s Care on Camera competition.
His winning image shows a community
nurse dressing the wound of an elderly
patient in his flat, representing the
importance of community health care in
the modern world. “I wanted to show the
truly caring interaction between nurse and
patient,” he said.
His photograph was chosen from
more than 800 entries in a nationwide
competition to capture the diversity of
contemporary nursing in the UK. Other
RCN BULLETIN JULY 2016
winners include Conrad Lee, who took the
silver award. His picture focused on the
importance of scrub nurses as part of the
surgical team. The People’s Choice Award,
voted for by the general public, went to
Kate Fawcett for an image of a patient
violinist and his nursing team at Forth
Valley Royal Hospital.
Care on Camera was open to amateur and
professional photographers and was run
in association with the Royal Photographic
Society and sponsored by NHS Employers.
The competition shortlist, including the
winning photographs, will now form
a touring exhibition visiting schools,
libraries, and various health settings
around the UK. Visit http://tinyurl.com/
care-on-camera to see all the images.
It is harder than ever to recruit and hold on
to high-calibre nurses with the specialist
skills we need. The financial and practical
support available for providers to train and
develop nurses is increasingly scarce.
Delivering a consistent standard of care
24/7 is getting harder and important
decisions need to be made about what we
need to be doing, who should be doing it,
and how it is going to be properly funded.
The debate at Congress allowed us to
address some of the issues around sevenday NHS service provision. We didn’t
solve this complex challenge in one sitting,
but we did discuss how we can keep
sustainable, universal health services at
the core of what we do.
http://tinyurl.com/7daycare
WWW.RCN.ORG.UK/BULLETIN
6 OPINION
WHAT IM
THINKING
What you’ve been saying
No easy option
Abortion is not an easy solution (RCN
Bulletin 340, “What I’m thinking”).
Having befriended older women who
had an abortion when younger, I know
that trauma, grief, pain, guilt and regret
last into old age and can affect family
relationships even 60-plus years later.
Carey Johnson
Specialist nurse, sickle cell
disease and thalassaemia
I decided to submit a Congress matter for
discussion after speaking to my clients
about the struggles they face.
Sickle cell disease (SCD) is one of the most
common genetic disorders in Britain. It
affects about 15,000 adults and children
and can lead to episodes of severe pain.
These may require hospital treatment
and without the right care can even cause
death. Yet fewer than half of people with
SCD say that staff in emergency settings
know enough about the condition.
Raising awareness is part of my role as
a specialist nurse, and it was important
to have this Congress discussion because
people are moving around the country
and finding that specialists are just not
there to help them. They should be able to
feel confident that the care they receive,
wherever they are, is equally good. Poor
care doesn’t just affect quality of life; it can
put the patient’s life at risk.
Two things would make a huge difference.
First, more specialist services; secondly,
better training in SCD for health care staff.
Nurses and others want to do the best for
their patients but can’t without the right
training and guidance.
That’s why we raised this crucial issue.
Better care for people with SCD starts with
better awareness – and we’re determined
to make that happen.
http://tinyurl.com/rcn-scd
WWW.RCN.ORG.UK/BULLETIN
Abortion is no easy option long term and we
are failing mothers, and sometimes fathers,
if we pretend it will have no more effect on
them than having their toenails cut.
Emotional and physical negative effects
of abortion include depression, anxiety,
low self-esteem, emotional numbing,
flashbacks and post-traumatic stress.
Even long after the child would have
grown up, the mother will, potentially,
still be grieving. The focus on women’s
health is becoming very muddied with the
convenience of modern society. It should
not be forgotten that with actions there
are consequences, and these can bring a
lifetime of misery, guilt and regrets.
Iris Hawkey, by email
Prince charming
A special thank you to the RCN for selecting
me to attend a royal garden party as part
of the centenary celebrations. Not in my
wildest dreams could I have imagined
meeting and having a chat with a member
of the royal family, let alone Prince William.
I not only shook his hand in a Kenyan style,
which he understood better than anyone
I have met in England, but we had a little
chat in Kiswahili, which he spoke with a
true Kenyan accent! Amazing.
Margaret Okiki, by email
QUOTE OF THE MONTH
By joining together, we can change things for the
better, for our patients, for our colleagues and for
ourselves. That is our strength.
RCN President Cecilia Anim in her opening speech at Congress
I’VE BEEN READING...
3 THINGS I BELIEVE
The Last Days of Rabbit Hayes is full of
warmth and humour. In it, we enter
into the life of Rabbit as her mother
drives her to a hospice for terminal
care. Surrounded by parents, siblings,
friends and her 12-year-old daughter,
Rabbit has decisions to make. This
book focuses on each personality
connected to Rabbit’s situation and how
relationships are affected by illness.
How often do we care for dying patients
without a clue of the journey they have
been on and the problems that they
have to face?
1.Though revalidation has been a hassle,
it has made us stop and reflect.
2.We must always help patients maintain
their dignity and general wellbeing.
3.In the area of child protection we
should listen to our gut instinct.
Janet Rose, nurse duty manager
Angela Pearce, school nurse
GOT SOMETHING TO SAY?
The RCN Bulletin team is always
looking for members to contribute to
the opinion pages. If you’re keen to
share your views, email
[email protected]
RCN BULLETIN JULY 2016
7
Share your thoughts on nursing issues.
Email [email protected]
HOT TOPIC
What difference
would legal nurse
staffing levels make
to you?
“It would be better for patients”, says
ward manager Heidi Perryman. “On
days that I’m fully staffed, the ward is
calmer and it does reduce the length of
stay for patients. Temporary staff don’t
always know the ways you work.”
“It would make my workplace a lot
happier,” says cardiac nurse Trevor
Oakes. “We regularly have to cover
our sister wards when they’re short,
so having legal levels would improve
our working environment and allow
us to get paperwork done without
feeling rushed.”
Hamish Kemp, a community learning
disability nurse, believes there should
be legal safe staffing levels for all nurse
settings, not just acute. “Legal staffing
levels should be equally appropriate in
any care environment – community,
district nursing and everywhere else.
Patients deserve safe staffing. At the
moment it’s completely unsafe.”
Trevor suggests that staff are
employed to be on call and paid a
retainer to be available if they’re
needed at short notice. “Bank staff
are under no obligation to cover
shifts. If it was part of someone’s
job to be on call, it would have a
positive impact as they would have to
come in.”
Care home nurse Renata Shagol
says it can only be a good thing for
patients and staff. “It’s important for
nurses and how they manage their
workload, especially with an ageing
workforce. Nurses can get burnt out if
they’re under pressure because of too
few staff.”
Shaping policy from the inside
Dame Donna Kinnair, RCN Director of
Nursing, Policy and Practice, insists nurse
leadership must be at the heart of
decision making
Plans to scrap the nursing policy unit
within the Department of Health are
extremely worrying.
Nurse leadership at the highest level is
the key to driving forward best practice
and health policy. But with these plans
the Government is cutting off its access to
impartial and balanced advice.
The Government has, sadly, set a trend in
failing to listen and as a result it gets some
policies, like the one on student funding,
very wrong.
Our ability to influence across the UK and
beyond is also lost, and the profession’s
influence in key international networks
is weakened. Without senior nurse
RCN BULLETIN JULY 2016
leadership
formulating and
interrogating
plans, these
trends looks set to
continue.
Throughout the
world, there is a
real appetite for
examples and
demonstrations of
best practice from
the UK that other
countries can learn from. Indeed, the RCN
works with sister organisations doing just
that. But we need a senior UK government
nursing voice to do the same.
Unless nursing advice and leadership
are put back at the heart of government
and given the prominence and respect
they deserve, the profession will be in the
permanent position of trying to shape and
alter policy from the outside.
MESSAGE
TO MEMBERS
Janet Davies
RCN Chief Executive
There is so much positivity to reflect
on following RCN Congress last week.
Members spoke passionately about what
needs to happen to improve health and
social care. But when I mull over what
you’re dealing with, I often think you
couldn’t make it up.
There aren’t enough nurses and that’s a
risk for patient care. So what do you do?
Take away the money that funds their
training? You find it hard to cover shifts
and must bring in agency nurses. So what
do you do? Cap the budget that pays for
them? You need to make cost savings.
So what do you do? Cut spending on the
people who keep the health service going?
This is no way to run an organisation.
So what would the RCN do?
We’d invest in clinical staff – assets, not cost
burdens. We’d increase rewards for working
unsocial hours to reduce agency costs;
invest properly in CPD; create a solid career
framework; engage in proper workforce
planning; keep the focus on patients. And
we would pay people properly.
We’ve got the answers but to persuade
others, we need you. So spread the word
via our Nursing Counts campaign. It may
not feel significant when you write to
politicians, go on a march, retweet – but
each action builds strength in numbers.
Please, work with us to make everyone
aware that nursing staff deserve better.
www.rcn.org.uk/nursingcounts
WWW.RCN.ORG.UK/BULLETIN
8 FEATURES
Supporting victims of abuse
The RCN will campaign for all health care workers to have mandatory domestic
abuse awareness training following an emotive debate at Congress
difference but in order for them
to be effective, we need education
covering all aspects of abuse, not
the adhoc singular modules of
training currently available.”
Not only will this benefit victims,
it has the potential to save the
NHS millions in preventing the
treatment of physical injuries,
avoiding in-patient stays, missed
appointments and reducing the
demands upon mental health
services, Amanda believes.
“Every nurse will come into
contact with domestic abuse in
their career,” says emergency
nurse Amanda Burston (pictured
above, centre), who presented her
argument to members at RCN
Congress in Glasgow last week.
“Victims have, on average, five
interactions with health care
professionals, including staff in
A&E, before receiving effective
support,” she says. “Emergency
departments are very busy
environments but they provide
an ideal opportunity to make a
difference. Nurses are well placed
to recognise, respond and refer
to a recovery programme if they
have the knowledge and skills.”
A recent Nursing Standard survey
found that almost one third of
nursing staff wouldn’t know how
to adequately support a victim
of domestic abuse or refer them
on for help. Sixty-two per cent
of those questioned said they
WWW.RCN.ORG.UK/BULLETIN
hadn’t recently received training
in treating victims, and of those,
most had never been trained in
caring for this vulnerable group.
As a survivor of abuse Amanda is
passionate about raising awareness
of the subject. “I have listened to
and witnessed the effects of abuse
on colleagues, patients and family
members. It creeps up on people
and before they know it their lives
are lost, their spirits broken, and
isolation and loneliness takes
over. A victim can fail to recognise
themselves any longer.”
Breaking the cycle
It’s Amanda’s view that education
for nursing staff can help them
engage with victims earlier to
break the cycle of abuse and save
them from prolonged suffering.
“Clawing your way back from
domestic violence can only begin
once disclosure takes place,” she
says. “Nursing staff can make a
The impact of
abuse creeps
up on people
and before they
know it their
lives are lost,
their spirits
broken
“The NHS is the only organisation
all victims of abuse engage with.
Nursing staff are in a unique
position to lead the way in
recognising, responding and
referring victims,” she adds.
The RCN is currently revising
its online guidance on how best
to support victims of domestic
violence. There will also be a
pocket guide available next year
to help nursing staff recognise the
signs of abuse and refer victims
on to appropriate services.
Carmel Bagness, RCN
Professional Lead for Midwifery
and Women’s Health, says: “We
recognise that there is established
safeguarding preparation in
pre-registration education, but
this could be strengthened. It
then needs to be built upon in
post-qualification education
across all areas of practice.
“Understanding how to recognise
and best support men and women
who suffer domestic violence
should be part of continuing
professional development for all
nursing and midwifery staff.”
Photo by
John Houlihan
Watch the full
Congress debate at
http://tinyurl.com/
rcn-domestic-abuse
RCN BULLETIN JULY 2016
9
Pay as you learn
Government proposals to replace bursaries with student loans
have been roundly condemned by RCN members
Who should foot the bill for the
training and education of nursing
staff in England? That’s the
question at the heart of a standoff
between the Government and
nursing unions, with the latter
implacably opposed to ministers’
plans to end the NHS bursary.
Earlier this year, the Department
of Health (DH) published
proposals on reforming health care
education funding, saying that
nursing students should take out
loans to pay for their education.
The DH argued that because
student places are largely paid
for by the NHS and therefore
subject to financial constraint,
universities are unable to meet
the demand for places. A more
“sustainable” funding system –
loans – would create up to 10,000
extra nurse training places by
the end of this parliament, the
Government said.
But a survey that informed the
College’s response to the DH
proposals shows members are
overwhelmingly opposed. Twothirds of respondents said they
would not have studied nursing
if they had been required to take
out a student loan. “Attrition
rates among student nurses
are incredibly high, and one
of the main reasons they drop
out is concern about debt,” said
one respondent.
Diversity concerns
The RCN has particular concerns
about the impact of student
loans on the diversity of the
nursing workforce. There are
RCN BULLETIN JULY 2016
Thousands of
RCN members
have spoken
out about these
damaging plans
cultural dimensions to debt –
for example, within the Muslim
community – and the prospect of
starting a nursing career in debt
will deter many mature students
with dependents, the College
argues. A student respondent to
the survey said: “At least 60 per
cent of my cohort have children
and say they wouldn’t be able to
study if it wasn’t for the
NHS bursary.”
Another major concern is the
effect of the proposals on the
number and quality of clinical
placements. The RCN says
that with mentors and support
structures already under strain,
the system will be unable to cope
with extra demand.
Search for
and download the
RCN Response to
the Department of
Health Consultation:
Changing How
Healthcare Education
is Funded at
www.rcn.org.uk
The College also points to
possible unintended
consequences of the plans.
Funding for post-registration
education, for example, could
also be hit and district nursing
in particular is especially
vulnerable to “stealth” cuts in
tuition funding.
The RCN is calling for
implementation of the proposals
to be suspended but says
it is ready to work with the
Government on alternatives
providing they are thoroughly
piloted, evaluated and riskassessed. “Forgivable” loans,
where all or part of the loan is
paid off by a nurse’s employer,
are among the other options put
forward by the College.
Survey facts
More than 17,000 members
responded to the RCN survey on
student funding.
• 89 per cent disagreed or
disagreed strongly with the
Government’s proposals.
• 70 per cent said the plans
would have a negative impact
on patient care.
• 81 per cent said registered
nurses had no capacity to
mentor more students.
• 80 per cent of nurse educators
disagreed or disagreed strongly
with the plans.
WWW.RCN.ORG.UK/BULLETIN
10 FEATURES
Living well with dementia
Improving the lives of people with dementia and their families is the aim of
an RCN initiative being piloted in independent care homes
One in three of us will develop
dementia. It’s estimated that
by 2021 one million people
in the UK will be living with
the condition. Dementia is
not a disease in itself, but a
condition that covers a range of
symptoms including memory
loss, depression and personality
changes. There is no cure.
Although people can still live
independently with dementia,
many who develop severe
symptoms move into residential
care as day-to-day tasks become
more difficult. The RCN is
piloting a nurse-led programme,
funded by the RCN Foundation,
to help improve the standard of
living for people with dementia in
independent care homes across
the UK.
Dawne Garrett, RCN Professional
Lead for the Care of Older People,
says: “We wanted to focus on
these settings as it’s where nurses
can feel more isolated and there is
less access to support.
“Many people with dementia
can’t verbalise if they’re in pain,”
she says. “If someone is showing
signs of distress, it’s often because
they’re uncomfortable.
so that if someone becomes
distressed, they realise it might be
caused by pain and can stop and
help, whether they’re a nurse or a
kitchen hand.”
Minimising distress
The pain assessment tool will
eventually be used in the other
homes involved in the project.
“We want our residents to be
happy and not distressed for any
reason,” adds Brenda. “This is
their home and we want to keep
them here and not in hospital,
which can be even more stressful
for someone with dementia.”
“As well as dementia, older people
in our care can also have arthritis
and other conditions, so we need to
make sure their pain is managed.
Using the assessment tool should
reduce the occurrence of a resident
getting overly distressed.”
The tool is already being used
by staff at Weavers House,
including care assistants,
cleaners and kitchen staff, who
have been trained in how to
identify the causes of pain. “It’s
a checklist that can be used to
pinpoint where the pain is, and
to help manage it effectively,”
adds Brenda. “We’re aiming to
heighten everyone’s awareness
We want to make
a lasting impact
on the care home
sector
Other homes in the programme
are focusing on activities which
help memory and promote
participation in activities such
as model-making and singing.
“Activities that make us feel
useful and important are essential
to maintaining a sense of selfworth,” explains Dawne.
“Some activities have tangible
“The aim of the programme is to
work with care homes to identify
areas they can improve. This
can be something simple like
decorating the rooms and making
them more “dementia friendly”
or setting up a new activity for
residents to be involved in.”
Brenda Rushe manages Weavers
House Care Home, a 65-bed
facility in Northern Ireland and
one of six homes taking part in
the pilot. She’s working with the
RCN to roll out a pain assessment
tool that focuses on reducing
distress for people with dementia.
WWW.RCN.ORG.UK/BULLETIN
Photos by
Elaine Livingstone
Visit www.rcn.
org.uk/dementia to
find out more about
the RCN’s work on
supporting patients
with dementia.
RCN BULLETIN JULY 2016
11
From the heart
VIEW
The THE
view from
here
FROM HERE
Feedback
Call to action
What I’m thinking
OnMargaret
the web McCambridge
Retired community mental
health nurse
TheWe
month
need toahead
see more being done to
support nurses who are working with
patients who have dementia in hospitals.
I have witnessed colleagues struggling
as they
are unsure how to deal with
In the
media
someone who has the condition.
outcomes, such as making something,
and other activities involve doing things
that give us pleasure and use areas of our
brains that still function well.”
Putting this into practice, older people
living at Greenlaw Grove Care Home in
Glasgow have started up their own choir.
“Residents wanted to set up a singing
group,” says Clinical Services Manager
Iona McKay (pictured left, in red). “The
feedback already indicates that it’s
improving their quality of life by taking
part in something. We practise every week
for an hour, but it sometimes runs over as
everyone loves it. It has created a real buzz
with the residents and staff and relatives
are loving it too.”
The choir is also a way to get residents
remembering lyrics and working towards
something together. It has drawn out
some unexpected talent among the
residents, Iona says.
“We have a keyboard player and a
resident who plays the ukulele. We’ll put
RCN BULLETIN JULY 2016
the song lists up in the day room areas
as a reminder for the residents what the
song choices are. It’s enjoyable, but also
connects with the community as we have
a link with a local school and we hope they
will be coming in to sing with the choir,
which will be lovely.”
Ongoing benefits
The choirs’ hard work will culminate
in a concert at the end of the summer.
“We hope it will continue once the RCN
programme has finished as it’s something
we’ve all enjoyed doing,” adds Iona.
All care homes involved in the scheme are
confident they’ll keep the changes they’ve
implemented once the pilot ends in
September. “It’s fantastic that the homes
we are working with have really taken on
board the difference they can make, even
by just making small changes. We really
want to make a lasting impact on the
care home sector and hope that we have
helped to improve the lives of people with
dementia in care homes,” adds Dawne.
A lot of things get assumed about older
people living with dementia. Incorrect
In my
day joblead to incorrect care
assumptions
planning. It can be more time consuming
trying to communicate with someone
with dementia and this has an impact
the care
they were
receive.
Theonway
things
I am concerned that the care of patients
with dementia is not good enough.
There are many reasons for this; time
Political action
pressures for nurses, but also the
environment. Hospitals just aren’t built
to accommodate the needs of people
with dementia. The setting can make a
confused person even more confused.
Just because someone has dementia,
they still have preferences and need to
be spoken to about what is happening to
them and treated with respect.
As a result of the recent debate at
Congress, I’d like to see the RCN running
more programmes for less experienced
nurses who are working with patients
who have dementia on the wards.
Catch up with all the action
from RCN Congress at
www.rcn.org.uk/congress
WWW.RCN.ORG.UK/BULLETIN
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11983_RCN_BULLETIN_A4_7573-2016.indd 1
25/05/2016 10:54
16 10:54
13
Fighting for trans equality
Tom Metcalf looks at what the RCN is doing to improve services for transgender people
As the first royal college to march
at a Pride event, back in 2003, the
RCN has been at the forefront of
promoting lesbian, gay, bisexual
and transgender (LGBT) rights
in recent years. The question of
trans rights in particular was first
brought to a wider RCN audience
at Congress in 2010, when
member Rachael Ridley proposed
a resolution calling on Council to
lobby for consistent and equitable
care for transgender patients.
There’s still a
societal stigma
around trans
people so our
job is to use our
resources to
tackle this
“Trans issues had never been
raised at Congress before,” recalls
Rachael. “During the process of
bringing the resolution forward we
found a lot of nurses weren’t aware
of the issues trans people face.”
Over the past six years, despite
some setbacks, progress has
been made in recognising the
discrimination trans people are
subjected to and taking steps to
tackle it.
In the East Midlands Guy Thomas
has been doing pioneering work
around improving services for
trans people since 2009, initially
as a member and, since 2011, in
his capacity as an RCN officer.
Guy runs regular training sessions
for public sector organisations to
help them better understand the
needs of trans service users.
“What I’ve found is organisations
tend to have a good knowledge
of other types of discrimination,
for example on the grounds of
age or ethnicity, but are often less
confident when it comes to trans
people,” he says.
The sessions cover how and how
not to address trans people,
commonly held stereotypes and
also look at the health journey they
RCN BULLETIN JULY 2016
go through, which may include
gender reassignment.
“After the training people are
more confident with things like
what terms to use and they also
have a better understanding of
the difficulties trans people face in
accessing services,” explains Guy.
Download
Fair Care for Trans
Patients: An RCN
Guide for Nursing
and Health Care
Professionals at
www.rcn.org.uk/
publications
The RCN will be
asking members
about their
experience of
health care for
trans patients –
keep an eye out
for a survey in the
coming weeks.
Changing attitudes
Although the sessions have had
excellent feedback, Guy hopes it
won’t be too long before they’re
no longer needed.
“Put it this way, I hope to be
redundant quite soon! In half a
generation I’m confident there
won’t be an issue – younger
people don’t see gender as a big
deal anymore.”
But he also admits more work
must be done, something echoed
in a report on transgender
equality by the House of
Commons Women and Equalities
Committee, published in January.
The report said the NHS, as well as
other public services, was “letting
down” trans people, and called
for public sector organisations to
agree a new strategy to tackle this
within six months.
New RCN guidance, launched
at this year’s Congress, will help
nurses in all settings to improve
care for trans patients, as RCN
Diversity and Equalities Coordinator Wendy Irwin explains.
“The guidance encourages
members to be positive and
sensitive when treating trans
people,” she says. “Although
they now have equality in a legal
sense, attitudes take a while to
change. There’s still a societal
stigma around trans people and
our job at the RCN is to use our
resources to tackle this. Thanks
to trailblazers like Rachael and
Guy, progress is being made.
But there’s much work still to
be done.”
WWW.RCN.ORG.UK/BULLETIN
14 FORUM FOCUS
Promoting the mental health
of young people
The RCN will campaign for greater psychological support for children
following a passionate debate at Congress
Members voted overwhelmingly
in favour of a resolution to lobby
the four UK governments to
invest in services to promote the
emotional wellbeing and positive
mental health of children and
young people.
The debate came as an RCN
survey found that without
substantial investment in school
nursing it won’t be possible to
provide children and young
people with effective mental
health support.
At least three children in every
classroom now suffer from a
mental health problem. But the
number of school nurses has
fallen by 10 per cent since 2010
to only 2,700 caring for more
than 9 million pupils. More than
two-thirds of those surveyed
said there were insufficient
school nursing services in their
area. Seventy per cent said their
current workload was too heavy,
while more than a quarter work
over their contracted hours every
day, reflecting the significant
pressure on the current school
nursing workforce.
Corina Christos from the RCN
Children and Young People’s
Staying Healthy Forum, who
proposed the Congress resolution,
said school nurses were uniquely
placed to provide the early
interventions that are key to
tackling mental health problems
in children and young people.
The RCN has called for urgent
investment in school nursing
to tackle the childhood mental
health crisis.
Chief Executive Janet Davies said:
“All children deserve access to the
right care, in the right place, at
the right time. Only by investing
in school nursing and wider
mental health services, can this
crisis be tackled and children be
given the best chance possible of
leading happy and healthy lives.”
Find out more
about the CYP
Staying Healthy
Forum at
http://tinyurl.com/
cyp-stayinghealthy
Every nurse an e-nurse?
Speakers at Congress raised concerns
about failing technology in a lively
debate exploring the concept that
every nurse should be an e-nurse,
as proposed by the RCN E-Health
Forum. “We want every nurse to be
fully equipped to do their job,” said
Forum Chair Ian Ireland.
He explained that the RCN is
developing a toolkit to enable
every nurse to embrace new
digital ways of working, following
two e-health events hosted by the
College last year.
Roger Cowell supported the
resolution and said: “If you can
WWW.RCN.ORG.UK/BULLETIN
We want every
nurse to be fully
equipped to do
their job
use 21st century resources to
support and improve patient care
and experiences, why wouldn’t you
be an e-nurse?”
But Kirk Panter told the hall:
“We need systems that work.
Paper records can go missing,
but computer systems go down.
I think nurses are being let down
by appalling IT systems.”
District nurse Vicky Smith added
that laptops and smart phones
used by her team often didn’t work
properly because of low signals and
batteries. Despite these concerns,
the resolution was passed.
RCN BULLETIN JULY 2016
15
Highlighting forum activity at RCN Congress 2016
Visit www.rcn.org.uk/congress to find out more
From the heart
Gastro forum tackles concerns over
the cost of constipation
With more than two million people suffering
with constipation in England, nursing
staff in all specialities will encounter this
common gastrointestinal disorder.
A guide to prevention and management of
this often painful condition was presented
during Congress by RCN Gastrointestinal
Forum member Brigitte Collins. She said:
“It can be a very distressing problem that’s
largely preventable and yet £59 million
was spent on hospital admissions for
constipation in 2013 with an average stay
of four days. There is an urgent need for
introducing clear guidelines which can
improve a patient’s quality of life and
reduce unnecessary costs to the NHS.”
THE VIEW
FROM HERE
The view from here
Feedback
Call to action
Join the RCN Gastrointestinal Forum at
www.rcn.org.uk and click on “get involved”.
What I’m thinking
Chris Carter
The best kept secret
OnChair
the web
of the RCN Defence
The sensitive subject of suicide prevention
was tackled at a Congress seminar
presented by members of the RCN Mental
Health Forum.
Thesituation
monthwhere
ahead
the number, severity
A major incident can be defined as a
or type of casualties, or the location,
requires extraordinary resources.
Families bereaved by suicide often say
that there is a reluctance for professionals
to share any information regarding
suicide risk.
Theymedia
can include terrorist attacks, such as
In the
those seen in recent months in Paris and
Brussels, but also natural disasters and
infectious diseases, like the Ebola outbreak.
In my day job
Training for health care staff on how to deal
with a major incident tends to focus on prehospital settings, but the knock-on effects
of any such event are wide-reaching.
Annessa Rebair, who presented the
seminar, said: “We looked at whether it’s
acceptable to share confidential information
without consent and how it affects nurses
in providing the best care while adhering to
the NMC code of conduct.”
The way things were
Promoting better
eye care
Developing guidelines
for delirium
“Eye care is not routinely taught to nursing
students unless they go on placement or
work on a specialist unit,” said Chair of
the RCN’s Ophthalmic Nursing Forum
Mary Shaw, speaking after a Congress
event organised to raise awareness of
optical health.
Members of the RCN’s Older People’s
Forum ran a session at Congress to gain
views on the required content of guidelines
for nursing people with delirium.
Delirium (or acute confusional state) is a
common clinical syndrome characterised
by disturbed consciousness, cognitive
function or perception, which has an acute
onset and fluctuating course. It usually
develops over one to two days but can be
prevented if treated early. The workshop
aimed to develop a consensus of opinion
on what advice nurses in all care settings
need to assess and treat the syndrome.
“Patients deserve the same attention to be
given to their eyes as any other body part,”
added Mary, stating the need for nursing
professionals to know how to administer
eye drops for patients if they’re prescribed
to them.
RCN BULLETIN JULY 2016
Nursing Forum
For example, if you work in an intensive
care unit you’ll need to keep treating the
patients already in the system, as well
as incoming
casualties. You may also
Political
action
find yourself having to deal with injuries
you’ve never seen before. If a hospital
itself comes under attack, you may find
yourself suddenly having to do your job
in a different setting.
The Defence Nursing Forum held an event
at Congress to help raise awareness of
major incidents and encourage members
to think about what would be expected of
them as heath care professionals.
All hospitals should have a major incident
plan. Do you know where yours is? Have
you read it? Would you know what to do?
Major incidents are rare in the UK, but
this makes training for them all the more
important. Don’t’ let it slip off the radar.
www.rcn.org.uk/forums
WWW.RCN.ORG.UK/BULLETIN
16 EVENTS
For details of more events visit the region
and country pages of the RCN website or
go to www.rcn.org.uk/events
Celebration of nursing
RCN International Centenary Conference
22-23 November
QEII Centre
London
This special international nursing event –
the first of its kind in the RCN’s history
– will celebrate 100 years of nursing by
reflecting on practices around the world.
Delegates and speakers will consider global
nursing developments and look towards the
future challenges and opportunities facing
the profession.
Hear from some of the most influential
voices in health including Dr Phumzile
Mlambo- Ngcuka, United Nations Under
Secretary-General, and Dr Jim Campbell
of the Global Health Workforce Alliance.
HCA learning event
With six keynote speakers and more than
120 sessions to attend, you will have the
opportunity to explore a range of topics,
from technology and innovation to society,
communities and relationships.
Dame Donna Kinnair, RCN Director of
Nursing, Policy and Practice, said: “It is
so important that as a profession we come
together to reflect, share best practice,
inspire and learn from each other so that
nursing practice is improved and patients
receive world-class treatment wherever
they’re cared for.”
RCN International
Centenery Conference
Tuesday 22 and Wednesday 23
November 2016
QEII Centre, London SW1P 3EE
Book today to benefit from the time-limited
early bird discount, which gives 25 per
cent off.
isit http://tinyurl.com/hg46pop to see
V
the full list of speakers, find out about
fees and book your place.
Mental health
Reflect, anticipate Recovery in
and celebrate
secure settings
19 July
Taunton Racecourse
Taunton
7 September
Macdonald Holyrood Hotel
Edinburgh
Health care assistants and assistant
practitioners are invited to reflect on nursing
past and present and consider what the
future holds for health care support workers.
Recovery is an individual and personal
process. This conference will challenge
those who work in mental health and
secure settings to consider how the
concept of recovery can be embraced and
realised, not only by the clients they work
with but also in their own practice.
The programme will address patient safety and
end of life care, and participants will consider
their own accountability in the workplace.
Call 02920 546460, quoting event code
2073, or visit http://tinyurl.com/hcaconf19july
WWW.RCN.ORG.UK/BULLETIN
The programme will appeal to all nurses,
health care support workers and students
who work in police custody services,
prisons and secure mental health settings.
Hear from Scotland’s Chief Nursing
Officer Fiona McQueen, network with
colleagues in your field and find out more
about the RCN’s work in this area.
Visit http://tinyurl.com/mentalhealth-recovery
RCN BULLETIN JULY 2016
18 CAREERS
Sound financial supervision
Nurse managers need to understand and control their budget and be
supported by trust management to spend it wisely, writes Erin Dean
An average ward has a budget of
about £1 million a year for staffing
and supplies. With responsibility
for its allocation often with the
ward manager or sister, budgeting
skills are essential.
Whoever holds
the purse strings
holds the power
Associate Director of Nursing at
Croydon Health Services NHS
Trust Jane Naish says matrons
will have responsibility for a
group of wards and, while not
the budget holder, will need
to understand spreadsheets
to reduce agency spend while
maintaining safe staffing levels.
Directors of nursing in all
settings need to have an oversight
of the nursing budgets, and
understand complex financial
arrangements, such as those in
cost improvement programmes
and commissioning.
Jane says nurses can learn some
of the skills on the job, but also
need training. “Good practice for
ward sisters is a monthly meeting
to go through finances with their
business accountant,” she explains.
Delivering quality
“Groups of ward sisters should
work together to look at supplies
and procurement in terms of
quality and cost effectiveness.”
The Nursing and Midwifery
Workload and Workforce
Planning Learning Toolkit,
published in 2013, points out
the responsibilities that come
with holding a budget, including
reviewing it on a regular basis
and ensuring that money is
spent appropriately.
An effective budget holds
statistical and financial details
on an individual band basis
to allow a comparison of skill
mix planned and deployed in
practice, according to advice
for ward managers from NHS
Education Scotland.
Budgeting is not relished by
many nursing managers. John
Power, a lecturer at Queen’s
University, Belfast, says nurses
are sometimes put off because
they are not confident in their
maths skills or are unable to use
the software provided.
John says that when a budget
is delegated properly to nursing
managers, it can empower them.
“Managers need to have a budget,
control the budget and have trust
management to stand behind
them,” he says. “The budget is
an important part of delivering
quality, effective, safe care.”
John urges nurse managers to
develop the budget in partnership
with their team, especially on
staffing. “Open up the books as far
as possible. The nursing team are
more likely to buy into it if they can
see there is not an agenda,” he says.
“Remember: whoever holds the
purse strings holds the power.”
This content is generated by RCNi.
For more go to www.rcni.com
WWW.RCN.ORG.UK/BULLETIN
RCN BULLETIN JULY 2016